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Biomedical subjects

O Kastrup

Publications and source records attributed to O Kastrup.

At least 19 recordsLinked to original sources
PubMed2005

Basal ganglia infarction mimicking glioblastoma.

Modern brain imaging techniques usually allow a very good differential diagnosis of intracerebral lesions, but in some cases the differential diagnosis is difficult. We report the case of a 52 year old male with acute brachiofacial paresis and a hyperintense lesion with mass effect and ring-enhancement in basal ganglia suspiciously to a tumor. The neurosurgeons recommend stereotactical brain biopsy for diagnosis, but the patient recovered in following time gradually and in repeated computer tomographic images contrast enhancement disappeared and a hypodense zone in the basal ganglia remains. Our case demonstrates that brain infarctions can mimick glioblastoma in taking cystic appearance and contrast enhancement. Stereotactic biopsy would have been a precipitated invasive procedure in this case.

Basal Ganglia↗
PubMed2004

Evolution of purely infratentorial PML under HAART--negative outcome under rapid immune reconstitution.

Progressive multifocal leukoencephalopathy (PML) caused by the polyomavirus JC is a well-recognised complication of AIDS. Purely infratentorial manifestations are rare. Introduction of highly active antiretroviral therapy (HAART) has been associated with a reduction in morbidity and an improvement in overall survival among HIV-infected individuals. Recently, several reports have described adverse events in patients with PML who begin HAART and show evidence for immune reconstitution. We describe the clinical course of two patients with PML with purely infratentorial manifestation, whose clinical course deteriorated despite the successful introduction of HAART. Possible underlying immunological mechanisms are discussed.

Adult↗
PubMed2004

Presumed pharmacologically induced change from upbeat- to downbeat nystagmus in a patient with Wernicke's encephalopathy.

A case of Wernicke's encephalopathy due to proven thiamine deficiency suffering from upbeat nystagmus (UN) changing to downbeat nystagmus (DN) after a latency of 1 year is presented. The case was also notable for the finding of positive oligoclonal bands in the CSF. The underlying pathophysiological mechanisms and a possible effect of baclofen treatment are discussed.

Adult↗
PubMed2004

Adult post-infectious thalamic encephalitis: acute onset and benign course.

We report on two young patients with an encephalitic syndrome and bilateral thalamic lesions following a presumably viral or mycoplasma respiratory tract infection with the main clinical symptoms of organic psychosis in the first and a prolonged amnestic syndrome and ataxia in the second case. Four months later the patients had recovered clinically and the thalamic lesions had resolved on magnetic resonance imaging in one case and almost completely in the other. We interpret the patients' illness as rare cases of a post-infectious acute thalamic encephalitis in adults. The cases and their relationship to possible post-infectious autoimmune inflammatory or toxic pathophysiological mechanisms are discussed and a review of the literature is provided.

Acute Disease↗
PubMed2004

[Restenosis of carotid artery after stenting associated bleeding in the vascular wall].

Stenting is an alternative procedure to the endarterectomy in patients with severe (> 70 %) symptomatic stenosis of the carotid artery. Its value is actually tested in large controlled randomised multicenter studies. Many vascular surgeons postulate no benefits for the patients but a higher complication rate for the stenting procedure. Especially the possibility of mechanical irritations of the endothel caused by the stent itself seems to be a major problem. Despite thousands of stenting procedures of the carotid artery, there exist no reports of patients with direct mechanical irritation of the carotid artery through the stent itself. It is only published a higher risk of embolisation. This case of a 71-years old patient, who had a irradiation of the head and neck region 5 years ago for cancer therapy, is presented here. After the irradiation (60 gr) the stent was not so fixed in the carotid wall as usually. Therefore the stent caused a mechanical irritation of the sclerotic plaque with a bleeding in the carotid wall and subsequent severe stenosis at the end of the stent with higher level of infarction volume. This case demonstrates the risk of the theoretical postulated irritation of the endothel through the stent itself in a high movement region.

Aged↗
PubMed2003

Evaluation of cortical excitability by motor and phosphene thresholds in transcranial magnetic stimulation.

Motor threshold (MT), as determined by transcranial magnetic stimulation (TMS), is used as a parameter of cortex excitability. In TMS with single or repetitive pulses, stimulus intensities in general are referred to the individual MT, although it is unclear whether MT also reflects the excitability of nonmotor cortical areas such as the visual cortex. Visual cortex excitability can be assessed by thresholds for eliciting phosphenes (phosphene threshold, PT) following TMS over the occipital cortex. The question of a different efficacy of TMS pulses in distinct cortical areas was approached by comparing motor and phosphene thresholds using single-pulse TMS applied to the primary motor and visual cortex. The aim of the study was to clarify, whether MT and PT correlate with each other and whether MT possibly serves as a reasonable measure for the excitability of the visual cortex. In 32 healthy volunteers, TMS with biphasic single pulses was applied over the motor and visual cortex with a figure of eight-shaped coil connected to a Dantec MagPro stimulator. MT and PT were individually measured (percent of maximal stimulator output). Mean PT (61.4+/-11.7%) was significantly higher than mean MT (39.4+/-5.9%) (p=0.01). MT and PT did not correlate significantly (r=0.29, p>0.1). These findings suggest that the MT does not reflect the excitability of the visual cortex. Regarding excitatory effects, the efficacy of TMS may be different over the motor and visual cortex, likely related to a different excitability of these cortical areas. This should be considered in planning and execution of TMS studies of nonmotor cortical areas.

Adult↗
PubMed2003

Wernicke's encephalopathy: unusual contrast enhancement revealed by magnetic resonance imaging.

Wernicke's encephalopathy is a serious neurologic disorder caused by vitamin-B1 or thiamine deficiency. The classical triad of clinical symptoms described by Wernicke (gait ataxia, ophthalmoplegia, and confusion) are found in only a third of patients upon initial examination. Typical findings upon MR imaging in patients with Wernicke's encephalopathy are well documented, with signal intensities in the medial thalami and periaqueductal regions of the midbrain. We report a case of Wernicke's encephalopathy revealing an unusual contrast enhancement. It is therefore important to note that the acute stage of Wernicke's encephalopathy may be associated with an intense contrast enhancement upon MR-imaging reflecting the disruption of the blood-brain barrier and inflammatory processes caused by thiamine deficiency. As a consequence from the guideline for managing Wernicke's encephalopathy by the Royal College of Physicians early B-vitamin treatment in suspected is recommended cases.

Acute Disease↗
PubMed2002

Progressive multifocal leukoencephalopathy limited to the brain stem.

Progressive multifocal leukoencephalopathy (PML) is a subacute demyelinating slow-virus encephalitis caused by the JC polyomavirus in 2-5% of patients with AIDS. MRI typically shows multiple lesions in the cerebral hemispheres. We present a rare case of rapidly evolving and lethal PML with a severe bulbar syndrome and spastic tetraparesis in a patient with AIDS. MRI showed high-signal lesions on T2-weighted images confined to the brain stem, extending from the medulla oblongata to the midbrain. JC virus polymerase chain reaction in cerebrospinal fluid was positive, and neuropathology showed the findings of PML. This case was also notable because of the rapid progression despite improved immune status with antiretroviral therapy.

AIDS-Related Opportunistic Infections↗
PubMed2002

Balo's concentric sclerosis. Evolution of active demyelination demonstrated by serial contrast-enhanced MRI.

We report a case of Balo's concentric sclerosis with peculiar MRI findings. Unlike previously published cases all concentric rings in our case showed marked enhancement, supporting the view of synchronous active demyelination in the lesion. Follow-up MRI disclosed a change of the lesions into a confluent pattern more resembling a typical large MS plaque. There were no oligoclonal bands or intrathecal Ig-G synthesis. The hypothesis concerning the pathophysiology of the lesions' typical and peculiar morphological appearance and its relationship to multiple sclerosis are briefly discussed.

Adult↗
PubMed2002

Posterior reversible encephalopathy syndrome due to severe hypercalcemia.

Posterior reversible encephalopathy syndrome (PRES) is a leukoencephalopathy clinically characterized by headache, altered mental status, visual loss and seizures. Neuroimaging demonstrates symmetrical posterior cortical and subcortical lesions. The exact pathophysiology is unknown but there is a strong association with immunosuppressants and hypertension. We report two cases of PRES in normotensive patients with severe hypercalcemia as the only identifiable cause. Possible pathophysiological mechanisms are discussed.

Aged↗
PubMed2000

Cortical motor reorganization following early brain damage and hemispherectomy demonstrated by transcranial magnetic stimulation.

BACKGROUND: Transcranial magnetic stimulation (TMS) was utilized to study 7 patients who had undergone hemispherectomy for control of longstanding intractable epilepsy to assess cortical motor reorganization and MEP (motor evoked potentials) ipsilateral to the remaining hemisphere. Five patients were seizure-free post-operatively. All patients displayed a spastic hemiparesis, were able to walk, raise and bend the paretic arm and use the paretic hand to different degrees. METHODS: We examined MEP threshold, site of maximal response to TMS, and latency to the biceps brachii, abductor pollicis brevis and the anterior tibial muscles using a 7 and 12 cm diameter round coil. RESULTS: The following results were obtained: (1) No MEP could be induced to either side by use of the small coil. (2) When using the large coil MEP-threshold was elevated also when stimulating the non-affected hemisphere in comparison to normal controls. (3) Ipsilateral MEP were found to: be non-inducible in two patients, demonstrate largely increased latencies in 3 and be identical to contralateral MEP in two patients. (4) Ipsilateral MEP could be evoked more often in distal than proximal muscles. (5) The site of maximal ipsilateral MEP response was found approximately 2 cm anteriorly to that of the contralateral MEP to the non-affected side of the body (6) No correlation was found between the degree of hemiparesis and inducability of MEP. CONCLUSIONS: The pattern of reorganization of ipsilateral motor control following early brain damage and hemispherectomy appears to be extremely diverse and does not correlate with the degree of neurological impairment.

Adult↗